Among the early cases Sir Spencer Wells reported one in which a pair of forceps was found in a patient’s bladder who died a month after ovariotomy. Olshausen mentions that a pair of forceps was passed by the rectum nine months after ovariotomy, and Terrillon tells of a pair of pressure forceps which remained eight months in the belly and came out close to the navel. One of the most remarkable instances is recorded by MacLaren, in which a pair of forceps was left in the abdomen in the course of a hysterectomy. Two years later, a swelling formed in the right iliac region; this was explored through an abdominal incision, and the hæmostatic forceps represented in Fig. 26 was found embedded in the omentum; the forceps had ulcerated into the cæcum and the blades were lodged in the vermiform appendix. The patient recovered.
Fig. 26. A Pair of Pressure Forceps: this instrument had remained in the abdomen two years after hysterectomy. The forceps had ulcerated into the cæcum and the blades had lodged in the vermiform appendix. (After MacLaren.)
In order to illustrate the diminished risks run by patients when the instruments and dabs used in operations are thoroughly sterilized, reference may be made to a case recently reported by J. E. F. Stewart (Australia), in which he removed a pair of pressure forceps which had remained in the abdomen for ten years and a half. The patient, who had been more or less an invalid since the primary operation, had suffered from attacks of acute pain, constipation alternating with diarrhœa, and pains in the lower limbs. The instrument, which measured 5 inches long and 2½ across the handles, was lying point downwards in the pelvis, and the ring handles could be felt through the belly-wall before the operation: it had made its way into the small intestine.
The tendency for a foreign body, whether hard like forceps, or soft like gauze pads, to erode its way into the intestine is very remarkable. Thus Gifford operated on a patient with intestinal obstruction; an impacted mass was felt in the ileum, it was extracted through an incision in the gut and proved to be a pad of cotton-wool enveloped in gauze. She recovered. Three months previously this woman had undergone abdominal myomectomy.
Another source of risk to patients is the practice or habit of packing the pelvic recesses with strips of gauze temporarily, either with the hope of controlling oozing, or to serve as a drain. I have long abandoned this habit. The disadvantage of gauze stuffing which needs consideration in this section is the risk that some portion, or the whole of it, is sometimes left in the wound. Examples are known where long strips of ‘gauze stuffing’, sometimes amounting to a yard or more, have been passed through the anus a year after the operation. Many intractable sinuses have had a forgotten piece of gauze as the cause of their persistence.
A woman had cœliotomy performed for peritonitis, the consequence of criminal abortion; she had a long convalescence due to an intractable sinus. Eventually the patient was thought to have tuberculous disease of the appendages, and a mass, formed mainly by the Fallopian tube, was removed. The walls of the tube were intact, but when slit open the tube was found to contain a small gauze tampon (Kouwer).
The isolated records relating to foreign bodies left in the abdomen are very numerous. Thus Wilson in 1884 was able to collect twenty-eight cases from periodical literature and personal reports from friends. An interesting discussion took place on the reading of a paper on this subject before an American gynæcological society, by R. W. Waldo, and the number of cases related by the members is astonishing and refer to such things as sponges, dabs, forceps, a strip of iodoform gauze ‘a yard wide and two yards long’, a pair of spectacles, and ‘an operating-room towel’, which were left in the abdominal cavity.
The most comprehensive collection of records relating to foreign bodies left in wounds of all kinds has been made by F. von Neugebauer; they amount to 195.